[Winona Online Democracy] Speaking from the experiences we have had this week in our pharmacy, it seems the program was launched without much planning or forethought by Medicare. We have spent more time on the phone trying to get problems and glitches cleared up this week than filling prescriptions and helping our patients with their meds. I personally spent two days over all time on hold waiting for help desks to answer or getting busy signals. Two of the help desks even tell you to call back after 5 or before 8am and then hang up on you. We have been able to serve the majority of our patients and have not refused service to anyone. Our pharmacy honors all but 1 of the 35 Mn approved Medicare D plans. The one we do not honor is RXAMerica. Their contract is so bad that no pharmacy can make any profit and in fact lose money on most prescriptions. We had a transfer to another local pharmacy that honors this plan and the pharmacist there told me that they lost money on 2 of the 4 prescriptions, broke even on 1 and couldn't fill the 4th without a prior approval from the company that would take a minimum of 72 hours, no exceptions. I agree with Craig. This plan is a mess. We have patients that have no idea what plan they are on and being dual eligible had a plan assigned to them. I compliment the hard working people in Social Services. They too have had to drop everything to help with this problem. Congress should have had Medicare set up their own PBM (Insurance company) and paid the pharmacies directly. I only ask that we all be patient with our pharmacies and pharmacists. We are all doing the best we can here in the Winona area. Most of us know our patients by name and are willing to work with them. Being a longer post, I won't even get into the impact this is having on those in long term care. That would take a much longer post as the regulations there are even more of a challenge Dick Gaffron R.Ph. ----- Original Message ----- From: "Craig Brooks" <[EMAIL PROTECTED]> To: "LTC Winona Group" <[EMAIL PROTECTED]>; "Poverty Roundtable" <[EMAIL PROTECTED]>; "WOD" <[email protected]> Sent: Friday, January 06, 2006 5:51 AM Subject: [Winona] Medicare Part D and low income
> [Winona Online Democracy] > > The article below reflects what is also happening in Winona this week. We > can do nothing about Part D locally and the pharmacists are being put in a > terrible position of financial risk. There are low income, frail people > needing life saving medications who are being told they are supposed to pay > $250 first -- all because of a mess created at the Federal level with this > Medicare Part D. I am sure our local Pharmacists will do everything they > can to avoid denial of necessary medications. But they can not be expected > to continue a cash flow problem that will cost them easily over a hundred > thousand a week for a small operation. If you know anyone who is having > trouble with this problem, please help them work something out with their > Pharmacist. AND, please contact Gutnecht and Coleman. > I hope I am wrong - but I expect this is NOT just a little glitch at the > beginning of a new program. I suspect this is a major problem where we are > just now seeing the tip of the iceberg. Personally, I believe Part D was > intended by its creators to benefit drug companies and HMOs with little, if > any, regard for the local druggist or especially for the poor recipients who > need the medications. > This system is so complex and expensive and harmful it is beyond words. We > must work to change this mess but in the meantime we need to help those who > might be forced to go without necessary medications person by person. > > Craig Brooks > > <(©¿©)> > > ************* > Last update: January 06, 2006 - 12:50 AM > Medicare flaw denies drugs for some poor > Officials are worried that many poor people may not be getting medicines > they need. > > Warren Wolfe, Star Tribune > Laura Monson, 65, is staying close to her subsidized apartment in > Minneapolis, severe leg pains restricting her movement, because her > pharmacist would not refill a prescription -- one of 11 drugs that have run > out. > > Hundreds and maybe thousands of poor Medicare beneficiaries like Monson have > been turned away from drugstores this week because of a major flaw in > implementing the program's new drug benefit, state officials said Thursday. > The problem is that the Medicare computer is telling pharmacists that these > beneficiaries are enrolled in a drug plan, but it's not confirming that > their poverty qualifies them for nearly free drugs. > > State officials became so concerned that they directed the state's > already-jammed Minnesota Linkage Line to drop nearly all other work and try > to resolve the problems. > > "I'm not a doctor, but I know it's not a good thing to go without your > medications," said Jim Varpness, head of the Minnesota Board on Aging, which > operates the Linkage Line. > > "It could be very, very bad," Varpness said. > > Not all poor people in that category -- dually eligible for Medicare and > Medicaid -- are having problems. Many are getting their drugs, some from > their regular pharmacists, who know them and take on faith that the problem > will be fixed. > > While spotty problems have been reported in other states, Medicare officials > said they appear to getting more complaints from Minnesota. > > 'Dual-eligibles' at risk > > The biggest problem is among "dual eligible" people who are on both Medicare > and Medicaid. > > They typically take more drugs and are in more frail health than other > Medicare beneficiaries, Varpness said. > > Until Jan. 1, their drugs were paid for by Medicaid. Under the new Medicare > law, those costs are being paid by one of about two dozen heavily subsidized > Medicaid drug plans operated by private insurers. > > To make sure there would be no break in coverage, all 6.2 million of them -- > 95,000 in Minnesota -- were automatically assigned by Medicare to drug pla ns > chosen at random. > > But starting Sunday, when the new benefit took effect, pharmacists found > that many of them were listed on a Medicare computer database as being > enrolled, but not as eligible for the subsidized portion of the plan. > > The subsidy allows them to pay between $1 and $5 per prescription, with no > deductible and no monthly insurance premium. > > In other cases, either Medicare or the private insurance companies appear to > have made errors in enrolling people. In addition, an overwhelmed Medicare > is simply behind in verifying that people who enrolled in plans actually > qualify. > > In a national conference call with pharmacists Thursday morning, Medicare > pleaded with drugstores to dispense drugs to those on Medicare and Medicaid > and to assume that the problems will be resolved soon. But Medicare > officials acknowledged that they could not compel pharmacists to do so. > > At the Minnesota Pharmacists Association, "We're hearing about pockets of > problems with dual-eligibles, but I'm hoping they're subsiding," said > executive vice president Julie Johnson. "Pharmacists are not the bad guys > here. They are spending a lot of time trying to help their customers." > > Problems have popped up at Astrup Drug, an 11-store chain of pharmacies in > southern Minnesota, pharmacy manager Tim Gallagher said. > > "But we're not sending anybody away," he said. "If we can see that they're a > dual-eligible, they get their prescriptions no matter what the Medicare > computer says." > > Help from Linkage Line > > The Linkage Line was already getting 7,000 calls a week about the new > benefit plan before the problem with dual eligibility surfaced. > > "We've had about 70 calls Tuesday and Wednesday from beneficiaries with this > problem," the Board of Aging's Varpness said. By Thursday afternoon, two > were "close to being resolved," he said. > > "If that many got through when we can't even answer all the calls we're > getting, how many didn't get through?" he said. "How many didn't even know > to call us?" > > He urged all dually eligible beneficiaries having trouble with the Medicare > drug benefit to call the Linkage Line, 1-800-333-2433. > > "These are poor people who are being told they have to pay a $250 > deductible, and then pay the full price for the drugs," said Rhonda > Peterson, a social worker with the nonprofit agency Volunteers of America > who works in a Minneapolis senior high-rise. "They just can't do that. Many > are just going without drugs they need." > > She's trying to help several clients, including Monson, who are having > problems with the Medicare benefit. > > Peterson said she thinks she may have convinced Monson's pharmacist to > dispense her drugs for this month and await confirmation that she's eligible > for the subsidy. > > "You know, this really isn't right," Monson said. "It's kind of frightening > when you don't know what's happening with your medications." > > Warren Wolfe . 612-673-7253 > > > _______________________________________________ > This message was posted to Winona Online Democracy > All messages must be signed by the senders actual name. > No commercial solicitations are allowed on this list. > To manage your subscription or view the message archives, please visit > http://mapnp.mnforum.org/mailman/listinfo/winona > Any problems or suggestions can be directed to > mailto:[EMAIL PROTECTED] > If you want help on how to contact elected officials, go to the Contact page at > http://www.winonaonlinedemocracy.org > _______________________________________________ This message was posted to Winona Online Democracy All messages must be signed by the senders actual name. No commercial solicitations are allowed on this list. To manage your subscription or view the message archives, please visit http://mapnp.mnforum.org/mailman/listinfo/winona Any problems or suggestions can be directed to mailto:[EMAIL PROTECTED] If you want help on how to contact elected officials, go to the Contact page at http://www.winonaonlinedemocracy.org
